Onychomycosis: strategies to improve efficacy and reduce recurrence.

Fungal infections may be difficult to treat for several reasons. It is important to obtain the correct diagnosis, and select the appropriate antifungal agent and route. General considerations that may be associated with recurrent infections are, a genetic predisposition and suboptimal bioavailability of drug, resulting in insufficient concentration at the target site. The aetiologic organism, the severity of disease, other coexisting diseases, concomitant drug intake, and the presence of fungal infection at other sites are some factors that determine the choice of antifungal therapy and its route of administration, oral vs. topical lacquer. Local factors such as the thickness of the nail, presence of lateral onychomycosis, longitudinal spike, dermatophytoma and severe onycholysis are some factors that may determine the choice of secondary measures such as mechanical or topical treatment. Booster or supplemental therapy may be of benefit when the response to initial treatment is poorer than expected and unlikely to result in complete response. Steps should be taken to reduce the possibility of recurrence once cure has been achieved.